A Disease for the Modern World

There is a rapidly escalating epidemic in the United States—a public health crisis that endangers the well-being and livelihood of our population. However, this threat cannot be controlled with inoculation or antivirals, and the long-term clinical, emotional, and economic implications are poorly understood at best. Although not considered a disease in the traditional sense, firearm injury contributes substantially to premature death, physical and psychiatric comorbidities, and medical spending each year in the United States. Injuries and fatalities due to gun violence result in more than $48 billion in combined medical spending and lost work cost annually (1). The effect of firearm-related injury is clear, so why isn’t the medical community talking about it more?

A recently published cohort study in Annals of Internal Medicine by Song and colleagues (2) examined health care outcomes after nonfatal firearm injury in both victims and their families. The results were both discouraging and wholly unsurprising. Medical spending increased by 402%, substance use disorders increased by 85%, and there was a 51% increase in psychiatric diagnoses compared with the control group (2). However, the damage didn’t stop at the survivors. Family members of those affected by firearm violence had a 12% increase in psychiatric diagnoses as well as increasing medical spending compared with the control (2). The effects of firearm injury are apparent on both an individual and community level, and that’s not even scratching the surface of disparities in gun violence. Racial and ethnic minorities as well as younger adults from low socioeconomic status households are disproportionally affected, which contributes to poor health equity (3, 4).

As a current second-year medical student, there is a great amount of focus within my education on prevention. Talking to patients about lifestyle modifications, cancer screenings, and vaccination all fall within our realm of responsibility to help our patients prevent disease to the best of our ability. Considering that firearm injury is theoretically an entirely preventable cause of morbidity and mortality, shouldn’t this also be our concern?

It can be easy to feel that tackling such a complex topic is futile, particularly when many physicians and health care workers are already overstressed and overworked. Perhaps it is unrealistic or naive to claim that firearm injury can be 100% prevented. There are a variety of practical actions that physicians and physicians-in-training can take to start working toward a safer community, including talking with their patients about appropriate gun storage in the home and lobbying for firearm laws that prioritize public safety. However, the first step toward change is awareness of the problem. If we take a step back and acknowledge the gravity of firearm injury in hospitals and communities, only then can we start to have a conversation about gun violence as a tangible, preventable cause of harm, rather than some uncontrollable danger that is inherent to the world we live in.

References 

1. Fowler KA, Dahlberg LL, Haileyesus T, et al. Firearm injuries in the United States. Prev Med. 2015;79:5-14. [PMID: 26116133] doi:10.1016/j.ypmed.2015.06.002
2. Song Z, Zubizarreta JR, Giuriato M, et al. Changes in health care spending, use, and clinical outcomes after nonfatal firearm injuries among survivors and family members. A cohort study. Ann Intern Med. 5 April 2022. [Epub ahead of print]. [PMID: 35377713] doi:10.7326/M21-2812
   
3. Beard JH, Morrison CN, Jacoby SF, et al. Quantifying disparities in urban firearm violence by race and place in Philadelphia, Pennsylvania: a cartographic study. Am J Public Health. 2017;107:371-373. [PMID: 28103077] doi:10.2105/AJPH.2016.303620
4. Centers for Disease Control and Prevention. National Violent Death Reporting System. Accessed at www.cdc.gov/violenceprevention/datasources/nvdrs/index.html on 31 March 2022.